Provider Demographics
NPI:1588478952
Name:CARTER, KACI LEE (PA-C)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:LEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W TUCSON ST APT 1117
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-7279
Mailing Address - Country:US
Mailing Address - Phone:704-477-4090
Mailing Address - Fax:
Practice Address - Street 1:303 E TAFT AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5655
Practice Address - Country:US
Practice Address - Phone:918-224-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant